Payment Policy: Visits On Same Day As Surgery Reference Number: CC.PP.040 Product Types: ALL Effective Date: 03/01/2018

Size: px
Start display at page:

Download "Payment Policy: Visits On Same Day As Surgery Reference Number: CC.PP.040 Product Types: ALL Effective Date: 03/01/2018"

Transcription

1 Payment Policy: Visits On Same Day As Surgery Reference Number: CC.PP.040 Product Types: ALL Effective Date: 03/01/2018 Revision Log See Important Reminder at the end of this policy for important regulatory and legal information. Policy Overview Evaluation and Management (E&M) services performed on the same day as a surgical procedure are included in the global surgical reimbursement package for the surgery and therefore are not separately reimbursable. Specific Current Procedural Terminology (CPT,) modifiers are taken into consideration prior to a denial determination. For purposes of this policy, same day visits address evaluation and management services that occur on the same day as the surgical procedure. The global surgical reimbursement package includes evaluation and management services, anesthesia, immediate post-operative care, written orders, evaluating the patient in the post anesthesia recovery area and typical postoperative follow-up care. To further clarify, the global surgical reimbursement package includes: 1. Pre-operative visits after the decision for surgery. Major procedures include visits that occur the day prior to and the day of surgery. 2. Minor procedures include visits that occur on the day of surgery. 3. Post-operative visits related to the patient s recovery from the procedure. 4. Intra-operative services that are a routine part of the surgical procedure during the course of surgery. 5. Additional medical or surgical services that require the surgeon s attention during the post-operative period of the surgery. This includes complications of surgery, but does not include return trips to the operating room. 6. Post-surgical pain management by the surgeon. 7. Supplies 8. Dressing changes, local incision care, removal of operative pack, cutaneous staples, sutures, etc. The global surgical period does not include: 1. The initial consultation or evaluation by the surgeon to determine the need for surgery. This is billed separately using the Decision for Surgery modifier. This modifier may only be used for major surgical procedures. 2. Services required by other physicians related to the surgery, except when the primary surgeon and other physician agree to transfer the patient s care. Modifiers -54 and -55 should be used to identify each physician s participation in the patient s surgical care. Modifier -54 denotes surgical care only, while modifier -55 denotes post-operative management only. Page 1 of 9

2 3. Treatment for the underlying condition that was the cause for surgery or for an added course of treatment which is not considered part of the normal recovery from the surgery process. 4. Diagnostic tests and procedures including diagnostic radiologic procedures. However, if the surgical procedure results in an inpatient admission, outpatient diagnostic testing and therapeutic services are bundled into the payment for the inpatient admission. 5. Distinct surgical procedures that occur during the post-operative period but are not related to treatments for complications from the original surgery or the need for a second operation related to the original surgery. 6. Treatment for post-operative complications requiring a return trip to the operating room. 7. Failure of a less extensive procedure that requires a more extensive procedure. 8. Immunosuppressive therapies for organ transplants. 9. Critical care services (CPT code & 99292) that are unrelated to the surgery. See Medicare Claims Processing Manual, Chapter 12, Section 40.1, for additional information. The purpose of this policy is to define payment criteria for E&M services when billed with surgical procedures having a 000, 010 or 090, MMM, and ZZZ global period to be used in making payment decisions and administering benefits. Application E&M services billed within the global surgical period applies to the following services: a. Inpatient hospital b. Outpatient hospital c. Ambulatory surgical centers d. Physician s E&M services Policy Description According to the Centers for Medicare and Medicaid Services (CMS), certain evaluation and management services are not separately reportable when billed on the same day as a minor, major or maternity procedure. Instead, these evaluation and management services are subsumed in the reimbursement for the surgical procedure. Necessary services performed before, during or after a surgical procedure are considered components of the surgical procedure. The global surgical period is determined by the number of post-operative days allowed for the surgical procedure. This policy refers to the following types of global surgical periods: Minor Surgeries and Endoscopies: 000-Zero Day Post-Operative Period. For minor surgeries and endoscopies with a 000 day global period, the global period applies only to visits and other services that occur on the same day as the surgery. Visits that occur on the same day as the surgery are not reimbursed as a separate service unless the visit is significant and separately identifiable from the reason for the surgery. The appropriate modifier (-25) must be appended to the E&M service when this occurs. The 000-day post-operative period is defined as: Page 2 of 9

3 a. No Pre-operative period. The global concept does not apply to visits and other services rendered the day prior to a surgical procedure. b. Same Day Visits Included. This means E&M Services that occur on the same day as a minor surgery or endoscopy are included in the global surgery reimbursement package and therefore are not payable as a separate service. c. No Post-operative period These procedures have no post-operative days assigned. This means that post-operative visits beyond the day of the minor surgery or endoscopy are not included in the payment amount for the surgery. Thus, they are separately reimbursable. d. Separate and Distinct Same Day Visits-Since an inherent E&M component is considered included in the reimbursement of a minor surgical procedure with a 000 day global period; it is not separately reimbursable. However, if the reason for the visit that occurred on the same day as a minor procedure or endoscopy is separate and distinct from the procedure, the provider may append the appropriate modifier (-25) to the E&M procedure code to document this occurrence. Minor Surgeries: 10-Day Post-operative Period. This includes other minor surgeries and some endoscopies. For minor surgeries and endoscopies with a 10 day global period, the global period applies to visits and other services that occur on the same day as surgery and the 10 days following the surgical procedure. Visits that occur on the same day as the surgery are not reimbursed as a separate service unless the visit is significant and separately identifiable from the reason for the original surgery. The appropriate modifier (-25) must be appended to the E&M service. The 10-day post-operative period is defined as: a. No pre-operative period. The global concept does not apply to visits and other services rendered the day prior to a surgical procedure. b. Same Day Visits Included. This means E&M Services that occur on the same day as a minor surgery or endoscopy are included in the global surgery reimbursement package and therefore are not payable as a separate service. c. 10-Day post-operative period. This means E&M services that occur within 10 days of the surgery are not payable as a separate service. d. The total global period is 11 days; the day of the surgery counts as day one and the 10 days following surgery. e. Diagnostic Biopsy Prior to Major Surgery. If a diagnostic biopsy with a 10-day global surgical period occurs before a major surgery, on the same day, or in the 10- day period; the major surgery is reported as a separate service. Major Surgeries: 90-Day Post-operative Period-this includes major surgical procedures. Visits on the day prior to the major surgery or on the same day as the major surgery are not reimbursed as a separate service. The 90-day post-operative period is defined as: a. One Day Pre-operative Period. This means the day immediately before the day of surgery is not payable as a separate service. Page 3 of 9

4 b. Same Day Visits Included. This means E&M Services that occur on the same day as a major surgery are included in the global surgery reimbursement package and therefore are not payable as a separate service. c. Decision for Surgery (Modifier -57). This means E&M services on the day before or on the day of the major surgery are reimbursable when those visits result in the decision to perform surgery. The appropriate decision for surgery modifier must be appended to the E&M service to document the decision for surgery. d. 90-Day Post-operative Period. This means E&M services which occur within the 90-days immediately following surgery are not payable as a separate service. e. The Total Global Period is 92 days; the one day prior to the surgery, the day of the surgery and the 90 days following surgery. Maternity Procedures: MMM-this includes maternity visits that occur during the period before childbirth (antepartum) and on the same day of the delivery procedure. Visits that occur during the antepartum period, on the same date of service, or during the post-operative period of 45 days are not recommended for separate reimbursement if the procedure includes antepartum or postpartum care. a. 270-Day antepartum. Preoperative period. b. Same Day Visits Included. This means visits that occur on the same date of delivery are included in the global maternity package and are not reimbursed as a separate service. c. 45-Day Post-partum period. This means E&M services which occur within the 45 days immediately following the delivery are not payable as a separate service. ZZZ Procedures-this includes surgical add-on procedure codes that must be billed with the primary surgical procedure and are defined as: a. Add-on surgical procedure codes. b. Must be billed with another primary service and cannot stand alone. c. When separate payment is made for an E&M service billed with a ZZZ surgical code, the provider is reimbursed for both the primary code and the add-on. d. The global surgical period is based off of the primary procedure code. If the primary procedure code includes an inherent E&M code, separate reimbursement is not allowed. e. The professional component modifier -26 may be appropriate for use with some procedures with a ZZZ global surgery indicator. The Medicare Physician Fee Schedule Data Base (MFSDB) is the source for the postoperative periods that apply to each surgical procedure. Reimbursement The Health Plan s code editing software will: 1. Evaluate claim lines, procedure codes, diagnosis codes and modifiers to determine if an evaluation and management service was billed on the same day as a surgery with a global surgical period of 000, 010, 090, MMM, and ZZZ days. Page 4 of 9

5 2. Claim lines containing E&M codes billed on the same day as a minor, major or maternity procedure will be denied. These services are considered included in the payment for the surgical procedure. 3. Modifiers -25, and -57 are considered prior to a denial determination. 4. This rule reviews claim lines billed on the same claim and across claims in patient s history. 5. This rule reviews claims billed across multiple dates of service. Documentation Requirements Modifier Claims lines billed with the modifier -25 appended to the E&M are subject to prepayment clinical claims validation by a registered nurse who is also a certified professional coder. Use of this modifier indicates that a significant, separately identifiable E&M service occurred on the same day as the surgery when the patient s condition required a visit beyond the normal pre-operative and postoperative care associated with the surgery. Use of the modifier is defined or substantiated by claims documentation that satisfies the relevant criteria for the respective E&M service to be reported. If the claims documentation does support that a significant and separately identifiable E&M service was performed; the E&M service is separately reimbursed, otherwise the E&M is denied. To avoid incorrect denials, providers should assign all applicable diagnosis codes that indicate the need for additional E&M service. Modifier Claim lines billed with the modifier -57 appended to the E&M are subject to prepayment clinical claims validation by a registered nurse who is also a certified coder. The nurse will analyze E&M and surgical dates of service, diagnosis codes, procedure codes billed and other claim information to determine if the initial decision to perform surgery occurred on the day before or the day of a major surgery. If the claim documentation supports the initial decision to perform surgery; the E&M service is separately reimbursed, otherwise the E&M is denied. Appeals/Reconsiderations In the event the provider disagrees with the prepayment claims edit determination, the provider has an opportunity to submit an appeal or reconsideration request (dependent upon health plan rules) for reconsideration of payment. All medical record supporting documentation must accompany the request. Coding and Modifier Information This payment policy references Current Procedural Terminology (CPT ). CPT is a registered trademark of the American Medical Association. All CPT codes and descriptions are copyrighted 2017, American Medical Association. All rights reserved. CPT codes and CPT descriptions are from current manuals and those included herein are not intended to be allinclusive and are included for informational purposes only. Codes referenced in this payment policy are for informational purposes only. Inclusion or exclusion of any codes does not Page 5 of 9

6 guarantee coverage. Providers should reference the most up-to-date sources of professional coding guidance prior to the submission of claims for reimbursement of covered services. CPT/HCPCS Code Descriptor General Ophthalmological Services; Established Patient Evaluation and Management Office and Other Outpatient Services, Established patient Observation Care Discharge Services Initial Observation Care, New or Established Patient Subsequent Observation Care Initial Hospital New or Established Patient Subsequent Hospital Care Observation or Inpatient Care Services (including admission and discharge services) Hospital Discharge Services Office or Other Outpatient Consultations; New or Established Patient Inpatient Consultations; New or Established Patient Critical Care Services; Use modifier -24 or -25 for critical care services unrelated to the reason for surgery or to the specific anatomic injury Nursing Facility Discharge Services Home Services Established Patient Modifier Descriptor -57 Decision for surgery: An evaluation and management service that resulted in the decision to perform the surgery. This situation is identified by appending the modifier -57 to the appropriate level of E&M service. This modifier is used when the decision for surgery occurred the day prior to or the day of a surgery with a 90-day global period since the day prior and the day of surgery is generally included in payment for the global surgical package. -25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service. ICD-10 Codes Not Applicable Descriptor Not applicable Page 6 of 9

7 Definitions: Global Surgical Package All necessary services normally furnished by a surgeon before, during and after a procedure. The payment for the surgical procedure includes all pre-operative, intraoperative and post-operative services performed routinely by a surgeon or from members of the same surgical group with the same specialty. Physicians in the same group practice, with the same specialty must be paid as though they were a single physician. Evaluation and Management Service (E&M) Physician-patient encounters that are represented by five digit Current Procedural Terminology (CPT ) codes used for billing and reimbursement. Specific documentation guidelines apply to these codes. The physician is responsible for documenting the patient s medical history, physical examination, medical decision-making, counseling, coordination of care, nature of the presenting problem and time spent with the patient. CPT codes are used for Medicare, Medicaid, Marketplace or private insurance encounters. Major Procedure A major procedure is defined as one with a 90-day global surgical period. Minor Procedure A minor procedure or endoscopy is defined as one with a 000 or 10-day global surgical period. Pre-operative Period The day before or the day of the procedure. The pre-operative period for a major surgery includes visits that occur the day before and the day of the major surgery. For minor or endoscopic procedures, this includes the E&M services the day of surgery. Post-operative Period The care received that begins at the end of the operation, in the recovery room, throughout the hospitalization and the outpatient period. Intra-operative Period Services that are carried out as part of a normal and necessary surgical service during the course of surgery. Antepartum Period The period occurring before childbirth. Page 7 of 9

8 Related Policies Policy Name Clinical Validation of Modifier 25 Pre-operative Visits Post-operative Visits Policy Number CC.PP.013 CC.PP.041 CC.PP.042 Related Documents or Resources MLN/MLNProducts/Downloads/eval-mgmt-serv-guide-ICN pdf 3. Guidance/Guidance/Manuals/Downloads/clm104 c12.pdf References 1. Current Procedural Terminology (CPT,) Department of Health and Human Services, Centers for Medicare and Medicaid Services. Medicare Learning Network: Global Surgery Fact Sheet Revision History 11/07/2016 Initial Policy Draft Created 03/01/208 Policy reviewed and updated, added Important Reminder For the purposes of this payment policy, Health Plan means a health plan that has adopted this payment policy and that is operated or administered, in whole or in part, by Centene Management Company, LLC, or any other of such health plan s affiliates, as applicable. The purpose of this payment policy is to provide a guide to payment, which is a component of the guidelines used to assist in making coverage and payment determinations and administering benefits. It does not constitute a contract or guarantee regarding payment or results. Coverage and payment determinations and the administration of benefits are subject to all terms, conditions, exclusions and limitations of the coverage documents (e.g., evidence of coverage, certificate of coverage, policy, contract of insurance, etc.), as well as to state and federal requirements and applicable plan-level administrative policies and procedures. This payment policy is effective as of the date determined by Health Plan. The date of posting may not be the effective date of this payment policy. This payment policy may be subject to applicable legal and regulatory requirements relating to provider notification. If there is a discrepancy between the effective date of this payment policy and any applicable legal or regulatory requirement, the requirements of law and regulation shall govern. Health Plan retains the right to change, amend or withdraw this payment policy, and additional payment policies may be developed and adopted as needed, at any time. Page 8 of 9

9 This payment policy does not constitute medical advice, medical treatment or medical care. It is not intended to dictate to providers how to practice medicine. Providers are expected to exercise professional medical judgment in providing the most appropriate care, and are solely responsible for the medical advice and treatment of members. This payment policy is not intended to recommend treatment for members. Members should consult with their treating physician in connection with diagnosis and treatment decisions. Providers referred to in this policy are independent contractors who exercise independent judgment and over whom Health Plan has no control or right of control. Providers are not agents or employees of Health Plan. This payment policy is the property of Centene Corporation. Unauthorized copying, use, and distribution of this payment policy or any information contained herein are strictly prohibited. Providers, members and their representatives are bound to the terms and conditions expressed herein through the terms of their contracts. Where no such contract exists, providers, members and their representatives agree to be bound by such terms and conditions by providing services to members and/or submitting claims for payment for such services. Note: For Medicaid members, when state Medicaid coverage provisions conflict with the coverage provisions in this payment policy, state Medicaid coverage provisions take precedence. Please refer to the state Medicaid manual for any coverage provisions pertaining to this payment policy. Note: For Medicare members, to ensure consistency with the Medicare National Coverage Determinations (NCD) and Local Coverage Determinations (LCD), all applicable NCDs and LCDs should be reviewed prior to applying the criteria set forth in this payment policy. Refer to the CMS website at for additional information Centene Corporation. All rights reserved. All materials are exclusively owned by Centene Corporation and are protected by United States copyright law and international copyright law. No part of this publication may be reproduced, copied, modified, distributed, displayed, stored in a retrieval system, transmitted in any form or by any means, or otherwise published without the prior written permission of Centene Corporation. You may not alter or remove any trademark, copyright or other notice contained herein. Centene and Centene Corporation are registered trademarks exclusively owned by Centene Corporation. Page 9 of 9

Payment Policy: Assistant Surgeon Reference Number: CC.PP.029 Product Types: ALL

Payment Policy: Assistant Surgeon Reference Number: CC.PP.029 Product Types: ALL Payment Policy: Reference Number: CC.PP.029 Product Types: ALL Effective Date: 01/01/2014 Last Review Date: 03/01/2018 Coding Implications Revision Log See Important Reminder at the end of this policy

More information

Payment Policy: Problem Oriented Visits Billed with Preventative Visits

Payment Policy: Problem Oriented Visits Billed with Preventative Visits Payment Policy: Problem Oriented Visits Billed with Preventative Visits Reference Number: CC.PP.052 Product Types: ALL Effective Date: 11/1/2017 Last Review Date: Coding Implications Revision Log See Important

More information

Payment Policy: High Complexity Medical Decision-Making Reference Number: CC.PP.051 Product Types: ALL

Payment Policy: High Complexity Medical Decision-Making Reference Number: CC.PP.051 Product Types: ALL Payment Policy: High Complexity Medical Decision-Making Reference Number: CC.PP.051 Product Types: ALL Effective Date: 6/2017 Last Review Date: See Important Reminder at the end of this policy for important

More information

Global Surgery Package

Global Surgery Package Private Property of Florida Blue. This payment policy is Copyright 2017 Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission

More information

IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY

IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY Global Surgery Policy Number GLS03272013RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 04/09/2014 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare

More information

Payment Policy: 30 Day Readmission Reference Number: CC.PP.501 Product Types: ALL

Payment Policy: 30 Day Readmission Reference Number: CC.PP.501 Product Types: ALL Payment Policy: 30 Day Readmission Reference Number: CC.PP.501 Product Types: ALL Effective Date: 01/01/2015 Last Review Date: 04/28/2018 Coding Implications Revision Log See Important Reminder at the

More information

Empire BlueCross BlueShield Professional Reimbursement Policy

Empire BlueCross BlueShield Professional Reimbursement Policy Subject: Global Surgery NY Policy: 0012 Effective: 02/01/2014 05/31/2014 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria

More information

Global Surgery Fact Sheet

Global Surgery Fact Sheet DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Global Surgery Fact Sheet Definition of a Global Surgical Package This fact sheet is designed to provide education on the

More information

GLOBAL DAYS POLICY. Policy Number: SURGERY T0 Effective Date: January 1, 2018

GLOBAL DAYS POLICY. Policy Number: SURGERY T0 Effective Date: January 1, 2018 GLOBAL DAYS POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: SURGERY 011.37 T0 Effective Date: January 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE LINES OF BUSINESS/PRODUCTS...

More information

Global Days Policy. Approved By 7/12/2017

Global Days Policy. Approved By 7/12/2017 Global Days Policy Policy Number 2018R0005A Annual Approval Date 7/12/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible for submission of accurate

More information

UniCare Professional Reimbursement Policy

UniCare Professional Reimbursement Policy UniCare Professional Reimbursement Policy Subject: Global Surgery Policy #: UniCare 0012 Adopted: 07/15/2008 Effective: 08/01/2017 Coverage is subject to the terms, conditions, and limitations of an individual

More information

Empire BlueCross BlueShield Professional Commercial Reimbursement Policy

Empire BlueCross BlueShield Professional Commercial Reimbursement Policy Subject: Global Surgery NY Policy: 0012 Effective: 10/01/2016 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria listed below.

More information

Anthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy

Anthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy Subject: Global Surgery IN, KY, MO, OH, WI Policy: 0012 Effective: 01/01/2018 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria

More information

KANSAS MEDICAL ASSISTANCE PROGRAM. Fee-for-Service Provider Manual. Podiatry

KANSAS MEDICAL ASSISTANCE PROGRAM. Fee-for-Service Provider Manual. Podiatry Fee-for-Service Provider Manual Podiatry Updated 03.2014 PART II Introduction Section BILLING INSTRUCTIONS Page 7000 Podiatry Billing Instructions.................. 7-1 Submission of Claim..................

More information

Clinical Policy: Automated Ambulatory Blood Pressure Monitoring Reference Number: CP.MP. 262

Clinical Policy: Automated Ambulatory Blood Pressure Monitoring Reference Number: CP.MP. 262 Clinical Policy: Reference Number: CP.MP. 262 Effective Date: 4/06 Last Review Date: 01/17 See Important Reminder at the end of this policy for important regulatory and legal information. Coding Implications

More information

KANSAS MEDICAL ASSISTANCE PROGRAM. Provider Manual. Podiatry

KANSAS MEDICAL ASSISTANCE PROGRAM. Provider Manual. Podiatry Provider Manual Podiatry Updated 07/2012 PART II Introduction Section BILLING INSTRUCTIONS Page 7000 Podiatry Billing Instructions.................. 7-1 Submission of Claim.................. 7-1 7010 Podiatry

More information

PAYMENT POLICY. Anesthesia

PAYMENT POLICY. Anesthesia IMPORTANT REMINDER This policy is current at the time of publication. Centene Corporation retains the right to change or amend this policy at any time. While this policy provides guidance regarding reimbursement,

More information

Modifiers 54 and 55 Split Surgical Care

Modifiers 54 and 55 Split Surgical Care Manual: Policy Title: Reimbursement Policy Modifiers 54 and 55 Split Surgical Care Section: Modifiers Subsection: None Date of Origin: 7/28/2004 Policy Number: RPM030 Last Updated: 7/3/2017 Last Reviewed:

More information

Global Surgery Package for Professional Claims

Global Surgery Package for Professional Claims Manual: Policy Title: Reimbursement Policy Global Surgery Package for Professional Claims Section: Administrative Subsection: None Policy Number: RPM011 Date of Origin: 1/1/2000 Last Updated: 3/6/2017

More information

Surgical Assistant DESCRIPTION:

Surgical Assistant DESCRIPTION: Private Property of Florida Blue This payment policy is Copyright 2017, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents w ithout the express w ritten permission

More information

OBSERVATION CARE EVALUATION AND MANAGEMENT CODES POLICY

OBSERVATION CARE EVALUATION AND MANAGEMENT CODES POLICY OBSERVATION CARE EVALUATION AND MANAGEMENT CODES POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 232.10 T0 Effective Date: March 1, 2017 Table of Contents Page INSTRUCTIONS

More information

Anthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy

Anthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy Subject: Documentation and Reporting Guidelines for Consultations IN, KY, MO, OH, WI Policy: 0030 Effective: 12/01/2016 Coverage is subject to the terms, conditions, and limitations of an individual member

More information

Same Day/Same Service Policy, Professional

Same Day/Same Service Policy, Professional Same Day/Same Service Policy, Professional Policy Number 2018R0002D Annual Approval Date 7/11/2018 Approved By REIMBURSEMENT POLICY CMS-1500 Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT

More information

This policy describes the appropriate use of new patient evaluation and management (E/M) codes.

This policy describes the appropriate use of new patient evaluation and management (E/M) codes. Private Property of Florida Blue. This payment policy is Copyright 2017, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission

More information

Non-Chemotherapy Injection and Infusion Services Policy, Professional

Non-Chemotherapy Injection and Infusion Services Policy, Professional Non-Chemotherapy Injection and Infusion Services Policy, Professional Policy Number Annual Approval Date 3/14/2018 Approved By Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy

More information

Modifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures

Modifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures Manual: Policy Title: Reimbursement Policy Modifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures Section: Modifiers Subsection: None Date of Origin: 9/22/2004 Policy Number: RPM010 Last Updated:

More information

Reimbursement Policy (EXTERNAL)

Reimbursement Policy (EXTERNAL) Subject: Consultations Reimbursement Policy (EXTERNAL) Effective Date: 01/01/15 Committee Approval Obtained: 06/06/16 Section: E&M/Medicine ***** The most current version of our reimbursement policies

More information

Reimbursement Policy. BadgerCare Plus. Subject: Consultations

Reimbursement Policy. BadgerCare Plus. Subject: Consultations Subject: Reimbursement Policy Effective Date: Committee Approval Obtained: Section: Evaluation and 04/20/18 04/20/18 Management *****The most current version of our reimbursement policies can be found

More information

Reimbursement Policy. Subject: Consultations Effective Date: 05/01/05

Reimbursement Policy. Subject: Consultations Effective Date: 05/01/05 Reimbursement Policy Subject: Consultations Effective Date: 05/01/05 Committee Approval Obtained: 06/06/16 Section: Evaluation and Management *****The most current version of the Reimbursement Policies

More information

Corporate Reimbursement Policy

Corporate Reimbursement Policy Corporate Reimbursement Policy Code Bundling Rules Not Addressed in ClaimCheck or Correct File Name: code_bundling_rules_not_addressed_in_claim_check Origination: 6/2004 Last Review: 12/2017 Next Review:

More information

Chapter 1 Section 16

Chapter 1 Section 16 General Chapter 1 Section 16 Issue Date: August 26, 1985 Authority: 32 CFR 199.4(c)(2)(i), (c)(2)(ii), (c)(3)(i), (c)(3)(iii), and (c)(3)(iv) 1.0 APPLICABILITY Paragraphs 3.1 through 3.7 apply to reimbursement

More information

MEDICAL POLICY Modifier Guidelines

MEDICAL POLICY Modifier Guidelines POLICY: PG0011 ORIGINAL EFFECTIVE: 10/30/05 LAST REVIEW: 12/12/17 MEDICAL POLICY Modifier Guidelines GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by

More information

Reimbursement Policy. Subject: Consultations. Committee Approval Obtained: Section: Evaluation and 07/01/17. Effective Date:

Reimbursement Policy. Subject: Consultations. Committee Approval Obtained: Section: Evaluation and 07/01/17. Effective Date: Subject: Consultations https://providers.amerigroup.com Reimbursement Policy Effective Date: Committee Approval Obtained: Section: Evaluation and 07/01/17 06/06/16 Management *****The most current version

More information

TELEMEDICINE POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: January 1, 2018

TELEMEDICINE POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: January 1, 2018 TELEMEDICINE POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 114.28 T0 Effective Date: January 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE LINES

More information

Programming a Spinal Cord Neurostimulator

Programming a Spinal Cord Neurostimulator Programming a Spinal Cord Neurostimulator August 10, 2017 My surgeon wants to bill 95972 for programming along with placement of a spinal neurostimulator. Isn t the programming inclusive to the surgical

More information

Anthem Blue Cross and Blue Shield Professional Reimbursement Policy

Anthem Blue Cross and Blue Shield Professional Reimbursement Policy Subject: Anesthesia CT Policy: 0020 Effective: 08/01/2014 01/31/2015 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria listed

More information

Empire BlueCross BlueShield Professional Commercial Reimbursement Policy

Empire BlueCross BlueShield Professional Commercial Reimbursement Policy Subject: Place of Service NY Policy: 0018 Effective: 12/01/2015 02/21/2016 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria

More information

Postoperative Sinus Endoscopy and/or Debridement Procedures

Postoperative Sinus Endoscopy and/or Debridement Procedures Manual: Policy Title: Reimbursement Policy Postoperative Sinus Endoscopy and/or Debridement Procedures Section: Surgery Subsection: None Date of Origin: 10/1/2009 Policy Number: RPM009 Last Updated: 7/3/2017

More information

Empire BlueCross BlueShield Professional Commercial Reimbursement Policy

Empire BlueCross BlueShield Professional Commercial Reimbursement Policy Subject: Prolonged Services NY Policy: 0019 Effective: 04/01/2016 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria listed

More information

Reimbursement Policy. Subject: Consultations Committee Approval Obtained: Effective Date: 11/01/13

Reimbursement Policy. Subject: Consultations Committee Approval Obtained: Effective Date: 11/01/13 Reimbursement Policy Subject: Committee Approval Obtained: Effective Date: 11/01/13 Section: E&M/Medicine 06/06/16 ***** The most current version of our reimbursement policies can be found on our provider

More information

Guidance For Modifier 24 Usage

Guidance For Modifier 24 Usage March 4, 2016 Guidance For Modifier 24 Usage Modifier 24 (Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period) has generated more scrutiny lately because of

More information

Inappropriate Payments Related to Procedure Modifiers. Medicaid Program Department of Health

Inappropriate Payments Related to Procedure Modifiers. Medicaid Program Department of Health New York State Office of the State Comptroller Thomas P. DiNapoli Division of State Government Accountability Inappropriate Payments Related to Procedure Modifiers Medicaid Program Department of Health

More information

CONSULTATION SERVICES POLICY

CONSULTATION SERVICES POLICY CONSULTATION SERVICES POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 256.3 T0 Effective Date: October 1, 2017 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE

More information

Anesthesia Services Policy

Anesthesia Services Policy Anesthesia Services Policy Policy Number Annual Approval Date 3/14/2018 Approved By Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare Medicare

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: observation_room_services 2/1997 3/2013 3/2014 3/2013 Description of Procedure or Service Observation services

More information

Empire BlueCross BlueShield Professional Reimbursement Policy

Empire BlueCross BlueShield Professional Reimbursement Policy Subject: Anesthesia Services NY Policy: 0020 Effective: 01/01/2015 11/30/2015 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria

More information

Post-Op hemorrhage repair. Is it billable?

Post-Op hemorrhage repair. Is it billable? Post-Op hemorrhage repair. Is it billable? August 10, 2017 Can I bill for taking the patient back to the OR to explore and repair post-op hemorrhage on day post-op? I heard that all complications are included

More information

Observation Services Tool for Applying MCG Care Guidelines

Observation Services Tool for Applying MCG Care Guidelines In the event of a conflict between a Clinical Payment and Coding Policy and any plan document under which a member is entitled to Covered Services, the plan document will govern. Plan documents include

More information

Anthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy

Anthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy Subject: Injection and Infusion Administration and Related Services & Supplies IN, KY, MO, OH, WI Policy: 0015 Effective: 05/01/2017 Coverage is subject to the terms, conditions, and limitations of an

More information

ALASKA. Official MEDICAL FEE SCHEDULE WORKERS' COMPENSATION

ALASKA. Official MEDICAL FEE SCHEDULE WORKERS' COMPENSATION Official ALASKA WORKERS' COMPENSATION MEDICAL FEE SCHEDULE Effective, 201 STATE OF ALASKA DISCLAIMER This document establishes professional medical fee reimbursement amounts for covered services rendered

More information

Clinical Policy: Home Phototherapy for Neonatal Hyperbilirubinemia Reference Number: CP.MP.150

Clinical Policy: Home Phototherapy for Neonatal Hyperbilirubinemia Reference Number: CP.MP.150 Clinical Policy: Reference Number: CP.MP.150 Effective Date: 12/17 Last Review Date: 12/17 See Important Reminder at the end of this policy for important regulatory and legal information. Coding Implications

More information

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to:

The ASA defines anesthesiology as the practice of medicine dealing with but not limited to: 1570 Midway Pl. Menasha, WI 54952 920-720-1300 Procedure 1205- Anesthesia Lines of Business: All Purpose: This guideline describes Network Health s reimbursement of anesthesia services. Procedure: Anesthesia

More information

Deleted Codes. Agenda 1/31/ E/M Codes Deleted Codes New Codes Changed Codes

Deleted Codes. Agenda 1/31/ E/M Codes Deleted Codes New Codes Changed Codes February 2013 Jean C. Russell, MS, RHIT jrussell@epochhealth.com Richard Cooley, BA, CCS rcooley@epochhealth.com 518-430-1144 2 2013 E/M Codes Deleted Codes New Codes Changed Codes Agenda Documentation

More information

February Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS

February Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS February 2013 Jean C. Russell, MS, RHIT jrussell@epochhealth.com Richard Cooley, BA, CCS rcooley@epochhealth.com 518-430-1144 2 2013 E/M Codes Deleted Codes New Codes Changed Codes Agenda Documentation

More information

Moderate Sedation PAYMENT POLICY ID NUMBER: Original Effective Date: 12/22/2009. Revised: 03/15/2018 DESCRIPTION:

Moderate Sedation PAYMENT POLICY ID NUMBER: Original Effective Date: 12/22/2009. Revised: 03/15/2018 DESCRIPTION: Private Property of Florida Blue. This payment policy is Copyright 2018, Florida Blue. All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission

More information

Observation Care Evaluation and Management Codes Policy

Observation Care Evaluation and Management Codes Policy Policy Number Observation Care Evaluation and Management Codes Policy 2017R0115A Annual Approval Date 3/8/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible

More information

Updated Only for Logo and Branding Provider Notice

Updated Only for Logo and Branding Provider Notice Updated Only for Logo and Branding Provider Notice To: From: PerformCare Network Providers Sheryl M. Swanson, MBA, Project Manager Date: December 21, 2012 Subject: AD12 112 2013 CPT Code Update IMPLEMENTATION

More information

Jurisdiction Nebraska. Retirement Date N/A

Jurisdiction Nebraska. Retirement Date N/A If you wish to save the PDF, please ensure that you change the file extension to.pdf (from.ashx). Local Coverage Determination (LCD): Independent Diagnostic Testing Facilities (IDTFs) (L31626) Contractor

More information

PECULIARITIES OF BILLING AND CODING IN LTC OCTOBER 14, 2011

PECULIARITIES OF BILLING AND CODING IN LTC OCTOBER 14, 2011 PECULIARITIES OF BILLING AND CODING IN LTC OCTOBER 14, 2011 PRESENTED BY ALVA S. BAKER, MD, CMD Maine Medical Directors Association Faculty Disclosures: Dr. Baker has disclosed that he has no relevant

More information

MODIFIER REFERENCE POLICY

MODIFIER REFERENCE POLICY Oxford MODIFIER REFERENCE POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 026.20 T0 Effective Date: November 1, 2017 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE

More information

Reimbursement Information for Contrast Enhanced Spectral Mammography (CESM) Services 1

Reimbursement Information for Contrast Enhanced Spectral Mammography (CESM) Services 1 GE Healthcare Reimbursement Information for Contrast Enhanced Spectral Mammography (CESM) Services 1 May 2018 www.gehealthcare.com/reimbursement This advisory addresses Medicare coding, coverage and payment

More information

Compliant Documentation for Coding and Billing. Caren Swartz CPC,CPMA,CPC-H,CPC-I

Compliant Documentation for Coding and Billing. Caren Swartz CPC,CPMA,CPC-H,CPC-I Compliant Documentation for Coding and Billing Caren Swartz CPC,CPMA,CPC-H,CPC-I caren@practiceintegrity.com Disclaimer Information contained in this text is based on CPT, ICD-9-CM and HCPCS rules and

More information

Observation Services Tool for Applying MCG Care Guidelines Policy

Observation Services Tool for Applying MCG Care Guidelines Policy In the event of conflict between a Clinical Payment and Coding Policy and any plan document under which a member is entitled to Covered Services, the plan document will govern. Plan documents include,

More information

Procedure Codes Assigned to Surgical Benefit Categories

Procedure Codes Assigned to Surgical Benefit Categories Manual: Policy Title: Reimbursement Policy Procedure Codes Assigned to Surgical Benefit Categories Section: Surgery Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM023 Last Updated: 4/5/2017

More information

VIRGINIA WORKERS COMPENSATION MEDICAL FEE SCHEDULES GROUND RULES JUNE 5, 2017

VIRGINIA WORKERS COMPENSATION MEDICAL FEE SCHEDULES GROUND RULES JUNE 5, 2017 VIRGINIA WORKERS COMPENSATION MEDICAL FEE SCHEDULES GROUND RULES JUNE 5, 2017 Contents Introduction... 3 Definitions... 4 General Information... 11 Application of the Medical Fee Schedules... 11 Exclusions

More information

Chapter 13 Section 2. Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups

Chapter 13 Section 2. Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups Outpatient Prospective Payment System (OPPS)-Ambulatory Payment Classification (APC) Chapter 13 Section 2 Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups Issue Date:

More information

Modifiers 80, 81, 82, and AS - Assistant At Surgery

Modifiers 80, 81, 82, and AS - Assistant At Surgery Manual: Policy Title: Reimbursement Policy Modifiers 80, 81, 82, and AS - Assistant At Surgery Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM013 Last Updated: 7/11/2017

More information

NEW PATIENT VISIT POLICY

NEW PATIENT VISIT POLICY NEW PATIENT VISIT POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 229.12 T0 Effective Date: November 1, 2017 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE

More information

Modifier -25 Significant, Separately Identifiable E/M Service

Modifier -25 Significant, Separately Identifiable E/M Service Manual: Policy Title: Reimbursement Policy Modifier -25 Significant, Separately Identifiable E/M Service Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM028 Last Updated:

More information

Outpatient Hospital Facilities

Outpatient Hospital Facilities Outpatient Hospital Facilities Chapter 6 Chapter Outline Introduce students to 1. Different outpatient facilities 2. Different departments involved in the reimbursement process 3. The Chargemaster 4. Terminology

More information

2018 Biliary Reimbursement Coding Fact Sheet

2018 Biliary Reimbursement Coding Fact Sheet The information contained in this document is provided for informational purposes only and represents no statement, promise, or guarantee by Cordis Corporation concerning levels of reimbursement, payment,

More information

UniCare Professional Reimbursement Policy

UniCare Professional Reimbursement Policy UniCare Professional Reimbursement Policy Subject: Anesthesia Services Policy #: UniCare 0020 Adopted: 02/03/2009 Effective: 02/07/2017 Coverage is subject to the terms, conditions, and limitations of

More information

Reporting Diagnosis Codes in ICD-10

Reporting Diagnosis Codes in ICD-10 Reporting Diagnosis Codes in ICD-10 My physician treated a patient for dysphasia secondary to an acute cerebral infarction in the inpatient rehab hospital. Do I need to report two diagnosis codes in ICD-10?

More information

Evaluation and Management Services

Evaluation and Management Services Evaluation and Management Services Print 1. If a physician sees a patient in the morning and again in the afternoon for a new or worsened condition, do we report modifier 25 for the second visit? 2. When

More information

February Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS

February Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS February 2013 Jean C. Russell, MS, RHIT jrussell@epochhealth.com Richard Cooley, BA, CCS rcooley@epochhealth.com 518-430-1144 2 2013 E/M Codes Deleted Codes New Codes Changed Codes Agenda Documentation

More information

Optima Health Provider Manual

Optima Health Provider Manual Optima Health Provider Manual Supplemental Information For Ohio Facilities and Ancillaries This supplement of the Optima Health Ohio Provider Manual provides information of specific interest to Participating

More information

Procedural andpr Diagnostic Coding. Copyright 2012 Delmar, Cengage Learning. All rights reserved.

Procedural andpr Diagnostic Coding. Copyright 2012 Delmar, Cengage Learning. All rights reserved. Procedural andpr Diagnostic Coding What is Coding? Converting descriptions of disease, injury, procedures, and services into numeric or alphanumeric descriptors Accurate coding maximizes reimbursement

More information

Contractor Information. LCD Information. FUTURE Local Coverage Determination (LCD): Debridement of Mycotic Nails (L35013) Document Information

Contractor Information. LCD Information. FUTURE Local Coverage Determination (LCD): Debridement of Mycotic Nails (L35013) Document Information FUTURE Local Coverage Determination (LCD): Debridement of Mycotic Nails (L35013) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Please note: Future

More information

Payment Policy 19.0 (Service Codes): Updated to reflect process changes since the implementation of Claim- Check.

Payment Policy 19.0 (Service Codes): Updated to reflect process changes since the implementation of Claim- Check. ANNUAL PAYMENT POLICY REVIEW PHP has completed its annual review of payment policies. The updated policies will be posted on ProvLink in January. Changes have been made to the following policies: Payment

More information

See the Time chapter for complete instructions on how to code using time as the controlling factor when selecting an E/M code.

See the Time chapter for complete instructions on how to code using time as the controlling factor when selecting an E/M code. 2015 EM Survival Guides Chapter 4: Initial Hospital Care (99221-99223) You should select the appropriate-level initial hospital care code (99221-99223) using the key E/M criteria of history, examination

More information

Cotiviti Approved Issues List as of April 27, 2017

Cotiviti Approved Issues List as of April 27, 2017 Cotiviti Approved Issues List as of April 27, 2017 Ambulatory Surgery Center (ASC); Outpatient Hospital 23 Inpatient Hospital 25 Inpatient Hospital; Inpatient Psychiatric Facility 27 Inpatient; Outpatient;

More information

NCD for Routine Costs in Clinical Trials (310.1)

NCD for Routine Costs in Clinical Trials (310.1) NCD for Routine Costs in Clinical Trials (310.1) Publication Number 100-3 Manual Section Number 310.1 Version Number 2 Effective Date of this Version 7/9/2007 Implementation Date 10/9/2007 Benefit Category

More information

CMS has finalized its proposal to eliminate Medicare payment for consultations and use the money from

CMS has finalized its proposal to eliminate Medicare payment for consultations and use the money from Consultation Services and Transfer of Care CMS has finalized its proposal to eliminate Medicare payment for consultations and use the money from these services to increase payments for visits, including

More information

MEDICARE RULE FOR TEACHING PHYSICIANS Effective July 1, 1996.

MEDICARE RULE FOR TEACHING PHYSICIANS Effective July 1, 1996. MEDICARE RULE F TEACHING PHYSICIANS Effective July 1, 1996. 1.0 GENERAL RULE: If a resident participates in a service provided in a teaching setting, the teaching physician may not bill Medicare for such

More information

Medicare Preventive Services

Medicare Preventive Services Medicare Preventive Services Presented by Part B Provider Outreach & Education December 16, 2015 Event Instructions Today s event is a teleconference Slides will not be advanced during the presentation

More information

MEDICAL POLICY No R1 TELEMEDICINE

MEDICAL POLICY No R1 TELEMEDICINE Summary of Changes MEDICAL POLICY TELEMEDICINE Effective Date: March 1, 2016 Review Dates: 12/12, 12/13, 11/14, 11/15 Date Of Origin: December 12, 2012 Status: Current Clarifications: Deletions: Pg. 4,

More information

Third Party Payer Days. IMGMA February 25, 2015

Third Party Payer Days. IMGMA February 25, 2015 Third Party Payer Days IMGMA February 25, 2015 Agenda 2015 Medicare Physician Fee Schedule Medicare Physician Fee Schedule Database Transitional Care Management - Reminder Medicare - Coverage Guidelines

More information

Empire BlueCross BlueShield Professional Reimbursement Policy

Empire BlueCross BlueShield Professional Reimbursement Policy Subject: Laboratory and Venipuncture Services NY Policy: 0029 Effective: 12/01/2014 07/31/2015 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products

More information

Jaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC Disclaimer

Jaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC Disclaimer Advanced Evaluation and Management More than a roll of the dice? History Exam Medical Decision Making Jaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC jaci@practieintegrity.com

More information

Chapter 9 Section 1. Ambulatory Surgical Center (ASC) Reimbursement

Chapter 9 Section 1. Ambulatory Surgical Center (ASC) Reimbursement Ambulatory Surgery Centers (ASCs) Chapter 9 Section 1 Issue Date: August 26, 1985 Authority: 32 CFR 199.14(d) Copyright: CPT only 2006 American Medical Association (or such other date of publication of

More information

Empire BlueCross BlueShield Professional Reimbursement Policy

Empire BlueCross BlueShield Professional Reimbursement Policy Subject: Bundled Services and Supplies NY Policy: 0008 Effective: 02/24/2014 06/30/2014 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and

More information

For Vanderbilt Medical Center Carolyn Buppert, NP, JD Law Office of Carolyn Buppert

For Vanderbilt Medical Center Carolyn Buppert, NP, JD Law Office of Carolyn Buppert For Vanderbilt Medical Center Carolyn Buppert, NP, JD Law Office of Carolyn Buppert www.buppert.com Describe the services in critical care that nurse practitioners perform that are billable Discuss what

More information

Department of Defense INSTRUCTION

Department of Defense INSTRUCTION Department of Defense INSTRUCTION NUMBER 6025.8 September 23, 1996 ASD(HA) SUBJECT: Ambulatory Procedure Visit (APV) References: (a) DoD Instruction 6025.8, "Same Day Surgery," July 21, 1986 (hereby canceled)

More information

Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date. Approved By

Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date. Approved By Policy Number 2016RP505A Facility-Based Behavioral Health Program Professional Fees Reimbursement Policy Annual Approval Date 09/30/2016 Approved By Optum Behavioral Reimbursement Committee IMPORTANT NOTE

More information

Billing, Coding and Reimbursement Guide

Billing, Coding and Reimbursement Guide Billing, Coding and Reimbursement Guide Revised June 2016 Disclaimer: The information in this document has been compiled for your convenience and is not intended to provide specific coding or legal advice.

More information

Chapter 13 Section 2. Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups

Chapter 13 Section 2. Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups Outpatient Prospective Payment System (OPPS)-Ambulatory Payment Classification (APC) Chapter 13 Section 2 Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups Issue Date:

More information

NIM-ECLIPSE. Spinal System. Reimbursement Brief

NIM-ECLIPSE. Spinal System. Reimbursement Brief NIM-ECLIPSE Spinal System Reimbursement Brief 1 NIM-ECLIPSE Spinal System Reimbursement brief NIM-ECLIPSE Spinal System The NIM-ECLIPSE Spinal System is a surgeon-directed and neurophysiologist-supported

More information

Modifier Reference Policy

Modifier Reference Policy REIMBURSEMENT POLICY Modifier Reference Policy Policy Number 2018R0111A Annual Approval Date 11/15/2017 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You

More information

CARE PLAN OVERSIGHT POLICY

CARE PLAN OVERSIGHT POLICY CARE PLAN OVERSIGHT POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 171.12 T0 Effective Date: June 1, 2017 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE

More information

Advanced Evaluation and. AAPC Regional Conference Chicago 10/27/12

Advanced Evaluation and. AAPC Regional Conference Chicago 10/27/12 Advanced Evaluation and Management AAPC Regional Conference Chicago 10/27/12 Jaci Johnson, CPC,CPMA,CEMC,CPC H,CPC I President, Practice Integrity, LLC jaci@practiceintegrity.com Disclaimer Information

More information